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REPORT 

OF  THE  COMMITTEE 

ON    THE 

ORGANIZATION  OF  THE 

NEW  PRESBYTERIAN  HOSPITAL 

ON   UNIVERSITY  LINES 


Printed  for  the  Trustees 
April  i,   1912 


''  z 


March  29,   1912. 

To  Nicholas  Murray  Butler,  LL.D., 

President,  Columbia  University,  New  York,  N.   Y. 

Dear  Sir: 

The  committee  called  together  by  you  to  prepare  a  scheme 
for  the  organization  of  the  new  Presbyterian  Hospital  on 
university  lines  would  report  as  follows: 

In  studying  the  needs  of  the  medical  school  in  the  hospital, 
it  has  considered  its  task  to  be  the  formulation  of  a  plan  for 
the  fullest  utilization  of  the  opportunities  which  the  new 
hospital  will  afford  the  University,  under  the  terms  of  the 
agreement  and  under  the  physical  conditions  which  will  exist 
during  the  continuance  of  the  school,  together  with  the  Sloane 
Hospital  and  Vanderbilt  Clinic,  at  its  present  location. 

The  Building  Committee  of  the  Hospital  has  recommended 
the  erection  of  a  hospital  to  contain  150  beds  each  for 
medicine  and  surgery,  exclusive  of  beds  for  children  and  for 
private  patients  and  of  beds  in  emergency,  isolation,  admission, 
and  other  special  wards.  Services  of  150  beds  each  will 
afford  an  opportunity  unequaled  in  this  country,  both  for  the 
systematic  instruction  of  large  classes  by  clinical  lectures  and 
for  the  education  of  at  least  100  students  a  year  as  clinical 
clerks,  as  at  present  carried  on  by  the  College  of  Physicians 
and  Surgeons.  They  will  equally  make  possible  a  lengthening 
and  broadening  of  the  curriculum,  should  that  at  some  future 
time  be  desirable. 

The  proper  direction  of  hospital  services  of  this  size  will 
require  all  the  energy  of  the  Professors  of  the  Practice  of 
Medicine  and  Surgery.  It  is,  therefore,  the  unanimous  opinion 
of  your  committee  that  the  entire  work  of  these  departments, 
both  in  teaching  and  in  research,  be  transferred  to  the  new 
hospital,  except  for  the  continuance  of  a  small  amount  of 
section  teaching  in  the  Vanderbilt  Clinic  and  Bellevue 
Hospital,  and  such  instruction  in  other  hospitals  as  may  be 
given  by  clinical  professors.  It  will  be  manifestly  impossible 
for  the  Professors  of  Medicine  and  Surgery  to  undertake  per- 
sonally instruction  or  the  supervision  of  work  outside  of  the 
hospital.       In  order   to   make  feasible  the  further  concentra- 

3 


M 


tion  of  their  activities  to  their  "  clinics,"  the  Building  Com- 
mittee of  the  Hospital  has  agreed  to  provide  consulting  offices 
for  them  in  the  new  hospital. 

A  hospital  of  the  size  contemplated  will  also  provide  the 
college  with  adequate  material  for  instruction  in  pathological 
anatomy  for  the  first  time  in  its  history.  The  Professor  of 
Pathology  will  be  obliged  to  spend  a  large  part  of  his  time  in 
the  supervision  of  the  pathological  work  of  the  hospital.  If 
he  is  to  accomplish  anything  in  investigation,  it  is  clear  that 
his  work,  as  well  as  that  of  the  Professors  of  Medicine  and 
Surgery,  must  be  under  one  roof.  Furthermore,  the  develop- 
ment of  the  institution  as  a  true  university  hospital,  along  the 
lines  contemplated  by  Mr.  Harkness  in  making  his  gift — 
already  made  somewhat  more  difficult  by  the  temporary  post- 
ponement of  the  plan  of  rebuilding  the  college  adjacent  to  the 
hospital — would  be  impossible  without  the  constant  association 
and  co-operatiQn  of  the  workers  in  the  clinical  departments 
and  those  in  the  pathological  department. 

Your  committee  is,  therefore,  unanimously  agreed  that  the 
entire  work  and  staff  of  the  Department  of  Pathology  must  be 
transferred  to  the  new  hospital. 

Such  transfer  of  the  three  departments  named  will  econo- 
mize not  only  the  time  of  the  instructors,  but  also  that  of  the 
students.  Your  committee  has  prepared  an  hour  curriculum 
card  for  the  second,  third,  and  fourth  year  classes,  based  on 
uch  an  arrangement,  and  has  shown  conclusively  that,  with  a 
very  trifling  rearrangement  of  courses,  the  students  of  the 
second  year  may  spend  half  a  day  a  week,  and  the  students  of 
the  third  year  four  whole  days  a  week,  at  the  hospital.  The 
fourth  year  curriculum  has  been  already  adjusted  for  hospital 
work  at  a  distance  from  the  school.  Such  a  modified  curricu- 
lum will  afford  a  much  needed  increase  in  the  hours  given  to 
pathology,  more  bedside  instruction,  systematic  clinical 
lectures  in  medicine  and  surgery,  and  other  advantages  which 
should  appeal  strongly  to  prospective  students.  It  will  make 
the  admission  of  students  to  advanced  standing  in  the  third 
year  much  less  objectionable,  because  it  would  guarantee  their 
thorough  education  in  pathology  hand  in  hand  with  clinical 
medicine  and  surgery.  At  the  present  time  such  students 
miss  the  bulk  of  the  instruction  in  pathology  in  the  college, 

4 


and  often  bring  an  inadequate  training  from  their  previous 
school. 

Under  this  arrangement  the  remaining  departments  would 
continue  to  give  their  instruction  at  the  college,  as  at  the 
present  time.  Considerable  space  for  their  better  accommoda- 
tion will  be  afforded.  The  Professors  of  Chemistry  and 
Bacteriology  should  become  respectively  consulting  chemist 
and  consulting  bacteriologist  to  the  hospital;  and,  if  they  so 
desire,  may  have  facilities  for  carrying  on  investigation  in 
conjunction  with  the  director  of  the  medical  or  surgical  clinic. 
They  should,  however,  not  have  routine  duties  ir/the  hospital 
while  the  college  remains  at  a  distance  from  it.  This  new 
curriculum  will  change  the  instruction  in  clinical  pathology  to 
the  second  half  of  the  second  year  and  at  the  same  time  will 
introduce  primary  courses  in  pathology  and  in  physical 
diagnosis.  The  Department  of  Clinical  Pathology  will  con- 
tinue to  give  its  instruction  in  the  school,  s6  that  when  the 
students  come  later  to  the  hospital  they  will  be  prepared  to 
apply  the  methods  already  learned. 

Your  committee  has  felt  that  the  structural  details  of  the 
new  hospital  must  express  the  details  of  its  organization,  if  it 
is  to  become  an  ideal  and  serviceable  university  hospital.  It 
has,  therefore,  as  a  preliminary  to  a  consideration  of  the  space 
required  for  educational  and  scientific  purposes  discussed 
plans  for  the  organization  of  their  respective  departments, 
prepared  by  the  Professor  of  Surgery,  the  Professor  of 
Pathology,  and  the  Professor  and  the  Assistant  Professor  of 
the  Practice  of  Medicine.  The  following  plans  have  the 
unanimous  approval  of  the  committee  and  are  transmitted  to 
you  as  setting  forth  the  lines  along  which  it  is  hoped  the  new 
hospital  may  be  developed,  and  as  containing  reasons  for  the 
space  which  your  committee  believes  the  University  will  need: 

Plan  of  Organization  for  the  Medical  Clinic  in  the 
New  Presbyterian  Hospital 

I.  Ward  service  of  150  beds,  to  be  organized  as  follows: 
General  wards,  132  beds  in  three  divisions  or  service  units, 
each  of  44  beds,  23  for  men,  18  in  ward,  5  in  smaller  rooms, 
one  for  3  patients  and  two  for  a  single  patient;  and  21  for 
women,  16  in  ward  and  5  in  similar  smaller  rooms. 

5 


Each  division  to  have  a  visiting  physician,  and  an  assistant 
visiting  physician,  who  shall  be  in  charge  of  the  out-patient 
service  of  the  division  and  take  the  ward  service  during  the 
absence  of  the  visiting  physician. 

Each  division  to  have  a  resident  and  an  assistant  resident 
physician,  with  salaries,  and  two  internes  without  salaries. 

Each  division  to  instruct  not  more  than    10  clinical  clerks. 

Each  division  to  have,  immediately  adjacent  to  its  wards, 
the  following  rooms  in  addition  to  the  necessary  service  rooms, 
lavatories,  etc. : 

i.  A  laboratory  for  all  the  routine  chemical  work  of  the 
division,  adequately  equipped  for  urine,  stomach  and  similar 
examinations,  and  of  sufficient  size  for  five  men  to  work  in  at 
one  time. 

2.  An  adjoining  and  communicating  laboratory  for  micro- 
scopic examinations,  equipped  with  an  incubator,  a  stone- 
topped  table  for  sputum  staining,  a  microscopic  table  for  the 
resident  staff  and  another  for  the  clinical  clerks,  microscopes, 
etc. 

3.  A  small  office  for  the  visiting  physician  and  resident. 

4.  A  teaching  room  for  demonstrations  to  sections  of  not 
more  than  20  students,  with  blackboard,  charts,  etc.  This  to 
contain  lockers  for  10  clinical  clerks. 

II.  Special  wards  for  the  more  elaborate  investigation  of 
patients,  eighteen  beds.  These  beds  should  be  in  small  rooms, 
4  with  three  beds  each  and  6  single  rooms.  Patients  to  be 
brought  to  these  wards  from  the  regular  wards  of  the  three 
divisions,  or  from  the  out-patient  service  as  determined  by  the 
director,  and  returned  to  the  regular  service  after  the  observa- 
tion shall  be  completed. 

This  service  to  be  under  the  immediate  supervision  of  the 
director  and  the  assistant  director  of  the  clinic,  and  organized 
for  thorough  research  work  along  any  line.  Beds  here  will  be 
available  for  members  of  the  staff  of  the  pathological  or  other 
scientific  departments,  when  the  observation  of  the  living 
patient  is  necessary  for  the  completion  of  experimental  studies 
undertaken  by  them,  subject  to  the  approval  of  the  director. 
Members  of  the  divisional  or  out-patient  staffs  may  also  be 
accorded  similar  privileges  at  the  discretion  of  the  director. 

6 


The  resident  staff  shall  consist  of: 

i.  A  chief  resident,  who  shall  have  general  charge  of  the 
service  and  of  the  private  patients  under  the  care  of  the 
director.      He  shall  also  act  as  chief  of  clinic. 

2.  An  assistant  resident,  who  shall  act  in  the  same  capacity 
for  the  assistant  director. 

3.  A  clinical  assistant  for  the  routine  laboratory  work  of 
the  private  patients. 

4.  Assistant  physicians,  who  may  or  may  not  be  residents, 
one  in  charge  of  each  of  the  laboratories  described  below. 

5.  Laboratory  assistants  as  may  be  needed. 

6.  Voluntary  assistants,  who  come  for  the  prosecution  of 
research  for  a  limited  time,  some  of  whom  may  hold  research 
fellowships. 

7.  A  permanent  nursing  staff,  especially  trained  for  the 
management  of  metabolism  cases,  etc. 

Conveniently  situated  with  reference  to  these  special  wards, 
if  possible  on  the  north  side  of  the  same  floor,  should  be  the 
research  laboratories  of  the  division,  as  follows: 

1.  Chemical  laboratories,  to  include  a  laboratory  for 
routine  clinical  chemistry,  a  Kjeldahl  digestion  room,  a  dis- 
tillation room,  and  if  possible,  three  small  laboratories  for 
individual  workers. 

2.  Physiological  laboratories,  to  include  a  complete  heart 
station,  and  a  room  for  physiological  apparatus  for  use  in  the 
wards,  a  room  for  the  assistant  physician  in  charge,  and 
another  small  room. 

3.  Biological  laboratories,  to  include  a  laboratory  for 
clinical  bacteriology,  a  laboratory  for  serological  work,  a  labor- 
atory for  the  examination  of  blood,  exudates,  etc.,  and  at 
least  two  rooms  for  individual  workers. 

There  should  be  a  room  for  the  small  experimental  animals 
necessary,  proper  store  rooms,  a  preparation  room,  and  a  room 
for  the  janitors. 

In  addition  there  should  be  a  small  office  for  the  resident 
and  one  for  the  assistant  resident  on  this  floor. 


Furthermore,  unassigned  space  should  be  left  on  this  floor 
for  future  expansion  of  the  scientific  activities  of  the  clinic 
along  lines  which  it  is  impossible  now  to  foresee. 

III.  Private  rooms. — Not  less  than  15  nor  more  than  25 
should  be  provided.  These  would  be  more  convenient  from 
the  standpoint  of  medical  care  if  situated  in  the  medical 
pavilion,  but  could  be  in  a  special  private  patients  building,  if 
that  be  important  from  the  administrative  standpoint. 

Private  patients  should  be  cared  for  by  the  resident  staff 
of  the  director  or  of  the  visiting  physician  in  charge  of  them. 
There  should  be  no  separate  staff  for  private  patients. 

All  private  patients  applying  at  the  hospital  should  be 
assigned  to  the  director  and  distributed  by  him,  as  he  sees  fit. 

TV.  Isolation  wards,  8  beds  in  separate  rooms. — These 
should  be  merely  for  the  care  of  cases  of  contagious  disease 
arising  in  the  hospital,  and  not  for  the  admission  of  contagious 
diseases  nor  for  instruction. 

V.  Medical  record  room. — The  medical  histories  should 
be  preserved  in  a  room  or  rooms  in  the  medical  building,  pre- 
ferably on  the  same  floor  with  the  library.  There  should  be 
at  least  one  large  fireproof  record  room  with  stacks  for  the 
bound  volumes,  and  smaller  rooms  for  the  history  clerk  and 
for  the  consulting  of  histories. 

VI.  Teaching  facilities. 

1.  One  teaching  room  on  each  of  the  three  divisions,  as 
already  specified. 

2.  A  medical  amphitheatre  for  250  students,  located  on 
one  of  the  lower  floors  of  the  medical  pavilion  and  near  the 
out-patient  department,  with  side  light,  preferably  from  the 
north.  This  must  be  equipped  with  automatic  window  cur- 
tains, projection  apparatus,  radiograph  box,  blackboards, 
laboratory  tables  for  showing  chemical  reactions,  microscope 
tables,  a  specimen  table,  a  reading  desk,  wash  basins,  etc. 
There  must  be  a  separate  entrance  for  students,  convenient  to 
students'  coat  room  in  the  basement  or  out-patient  department. 

8 


Adjacent  to  and  communicating  with  the  amphitheatre 
must  be  two  waiting  rooms,  one  for  male  and  one  for  female 
patients,  and  a  large  room  or  rooms  for  the  storing  of  the 
teaching  collection  of  charts,  models,  lantern  slides,  radio- 
graphs, museum  specimens,  etc. 

3.  The  library  of  the  clinic.  This  should  be  on  the  same 
floor  with  the  medical  amphitheatre,  and  convenient  to  the 
offices  of  the  director  and  assistant  director,  so  that  the 
department  secretary  may  supervise  it.  There  must  be  ample 
stack  room  and  a  large  reading  room. 

4.  Three  rooms  suitable  for  recitations  or  demonstrations, 
one  capable  of  holding  60,  the  others  30  students,  should  be 
provided  in  the  out-patient  department.  These  rooms  are  for 
the  use  of  both  medical  and  surgical  departments. 

5.  A  coat  room  for  students  should  be  provided,  prefer- 
ably near  the  out-patient  department,  with  accommodation  for 
250  students. 

6.  Students'  lavatories  for  the  same  number  should  be 
provided,  adjacent  to  the  coat  room. 

7.  A  lunch  room,  capable  of  serving  a  buffet  lunch  and 
with  some  tables  should  be  provided  for  students,  and  be  run 
at  a  small  profit  or  leased  to  a  purveyor. 

VII.    Accommodations  for  the  staff. 

1.  Consulting  offices  for  the  director  and  the  assistant 
director,  with  a  convenient  anteroom,  sufficiently  large  to 
accommodate  the  department  secretary  and  patients  and  other 
callers  should  be  provided  on  the  floor  with  the  amphitheatre 
and  library.  Communicating  with  these  consulting  offices 
should  be  a  small  examining  room,  a  dressing  room,  and  a 
small  clinical  laboratory. 

2.  Resident  staff  quarters  to  provide  for  20  men,  the  chief 
resident  and  assistant  to  have  a  study,  bedroom,  and  bath  ; 
the  division  residents  and  assistants  each  suites  of  a  study,  two 
bedrooms  and  a  bath;  the  internes,  two  bedrooms  and  a  bath 
for  each  division.  The  remaining  rooms  to  be  arranged  with 
a  bath  for  each  two  bedrooms  for  voluntary  assistants  or 
assistant  physicians  who  may  be  resident.      There  should  be  a 

9 


general  club  room,  a  reading  and  writing  room,  and  a  common 
dining  room. 

3.  A  lunch  room,  or  accommodations  in  the  staff  dining 
room,  for  luncheon  for  the  visiting  staff,  to  be  provided  at 
cost,  should  be  planned. 

VIII.  Out-patient  department. — The  out-patients'  rooms 
devoted  to  medicine  should  be  so  planned  that  each  of  the 
three  divisions  may  have  a  complete  unit,  consisting  of  two 
consulting  and  two  examining  rooms,  for  men  and  women 
respectively,  with  a  small  clinical  laboratory  between  the 
examining  rooms.  In  addition  there  should  be  a  unit  for 
tuberculosis,  possibly  one  for  diseases  of  metabolism  and 
one    for  gastrointestinal  diseases. 

There  should  be  a  consulting  room  for  the  director  of  the 
medical  out-patient  department  which  would  serve  also  for 
out-patient  consultations  by  members  of  the  visiting  staff. 

Three  rooms  for  demonstrations  or  recitations,  as  already 
specified.  These  would  be  used  for  both  medical  and  surgical 
instruction. 

IX.  Facilities  desired  by  the  medical  clinic  in  other 
departments  of  the  hospital. 

1.  X-ray  and  photographic  department.  This  department 
should  carry  on  work  for  the  whole  hospital.  For  the  special 
use  of  the  medical  service  there  should  be  a  room  for  fluoro- 
scopic examination  and  demonstration,  with  proper  protection. 

Arrangements  should  also  be  made  for  prints  of  photo- 
graphs and  reduced  radiographs  for  filing  with  the  medical 
histories 

2.  Department  of  physical  therapeutics  and  hydrotherapy. 
This  should  carry  on  treatment  as  ordered  both  for  ward  and 
private  patients  and  for  out-patients,  under  proper  limitations 
of  hours-  for  medical  and  surgical  services. 

3.  Social  service  department.  This,  again,  should  assist 
both  the  medical  and  the  surgical  services,  in  hospital  and 
out-patient  department,  by  a  proper  system  of  reference  and 
report.  A  special  system  of  following  up  medical  cases  should 
be  organized. 


4.  Pathological  department.  An  operating  room  large 
enough  for  kymograph,  etc.,  for  the  use  of  members  of  the 
medical  staff  who  desire  to  do  experimental  work  requiring 
larger  animals,  would  be  desirable.  Reports  should  be  furnished 
on  tissues  removed  from  patients  for  diagnosis.  Copies  should 
be  furnished  of  all  autopsy  protocols  to  complete  the  medical 
histories. 

5.  Machine  shop.  A  well-furnished  machine  shop  for  the 
repairing  of  instruments  from  all  departments  is  highly 
desirable. 

X.    Personnel  and  duties. 

Director,  the  Bard  Professor  of  the  Practice  of  Medicine. 

Hospital  duties:  General  supervision  of  the  entire  service; 
immediate  supervision  of  his  own  patients  in  special  rooms  and 
private  wards,  and  of  certain  laboratories  and  the  library. 
Rounds  with  chief  resident  daily  in  special  wards.  Consulting 
rounds  with  visiting  physician,  staff,  and  clerks  of  each  division 
twice  a  week.  Once  a  week  consultations  in  out-patient 
department.  Research.  Allowed  private  consulting  office 
practice  in  the  hospital  and  consultations  outside  of  the  hospital 
after  5  p.m. 

University  duties:  General  supervision  of  department. 
Clinical  lecture  three  times  a  week.  Clinical  and  pathological 
conference  once  a  week.     Seminar  once  each  week. 

Assistant  Director,  Associate  Professor  of  the  Practice  of 
Medicine. 

Hospital  duties:  To  take  the  place  of  the  director  in  the 
latter's  absence.  Immediate  supervision  of  his  own  patients 
in  special  wards  and  private  rooms,  and  of  certain  labor- 
atories. Daily  rounds  with  assistant  resident  physician. 
Once  a  week  consultations  in  out-patient  department.  Re- 
search. Allowed  private  consulting  office  practice  in  the 
hospital  and  consultations  outside  of  the  hospital  after  5  p.m. 

University  duties:  To  assist  in  supervision  of  department. 
Second  year,  elementary  clinic,  once  a  week,  one-half  year. 
Ward  visits  with  third  year  sections  twice  a  week.  To  sub- 
stitute for  director  in  certain  of  his  teaching. 

Visiting  Physicians,  Assistant  Professors,  or  Professors  of 
Clinical  Medicine. 

11 


Hospital  duties:  The  usual  duties  of  visiting  physicians 
to  their  divisions.  Rounds  daily  with  their  resident  staffs  and 
clinical  clerks.  Allowed  private  patients  at  the  discretion  of 
the  director,  depending  on  rooms  available.  Allowed  outside 
practice.  Consultations  in  their  out-patient  divisions  once  a 
week. 

University  duties.     Instruction  of  clinical  clerks: 

Associate  Visiting  Physicians.  Should  these  prove  desirable, 
they  may  be  appointed  at  any  time,  without  re-arrangement 
of  the  administrative  plan. 

Hospital  duties:  To  assist  in  the  care  of  ward  patients. 
To  substitute  for  the  visiting  physician  during  the  academic 
year,  and  in  charge  of  the  service  for  half  the  summer, 
alternating  with  the  assistant  visiting  physicians. 

University  duties:  To  assist  in  the  instruction  of  clinical 
clerks. 

Assistant  Visiting  Physicians,  Associates  in  Medicine. 

Hospital  duties:  Substitute  for  their  visiting  physician. 
Immediate  supervision  of  out-patient  service  of  their  division. 
Allowed  private  patients  in  hospital  at  discretion  of  director. 
Allowed  practice  outside. 

University  duties.  Recitations  in  medicine  and  physical 
diagnosis  instruction. 

All  physicians  attached  to  the  hospital  will  be  expected 
to  engage  in  clinical  investigation,  and  it  will  be  very  desir- 
able that  some  at  least  offer  special  advanced  courses. 

Director  of  oat-patient  department,  Assistant  Professor  of  the 
Practice  of  Medicine. 

Hospital  duties:  General  supervision  of  medical  out- 
patient department.  Supervision  of  medical  histories.  Sub- 
stitute for  assistant  director  in  his  absence  or  while  he  is 
acting  director,  or  for  visiting  physicians  in  emergency.  Care 
of  a  few  patients  in  special  wards  and  private  rooms.  Allowed 
limited  practice  outside  only. 

University  duties:  Supervision  of  physical  diagnosis 
instruction.  Recitations  in  medicine.  Assist  assistant 
director  in  ward  visits.  Prepare  out-patients  for  director's 
clinic  when  desired. 

Assistant  Physicians,  Instructors  or  Associates  in  Medicine. 

12 


Hospital  duties:  One  in  charge  of  chemical,  one  of  phy- 
siological, and  one  of  biological  work  of  the  service,  with 
responsibility  for  the  details  of  the  respective  laboratories. 
No  ward  duties.  They  may  be  resident  or  live  out  of  the 
hospital.  These  men  should  be  nominated  by  the  director 
after  consultation  with  the  heads  of  the  Departments  of  Chem- 
istry. Physiology,  and  Bacteriology  of  the  College,  and  may 
also  hold  positions  in  these  departments,  but  must  give  their 
entire  time  to  the  hospital. 

Chief  Resident  and  Assistant  Resident  of  the  special  wards 
to  be  appointed  for  an  indefinite  term  and  to  be  men  prepar- 
ing for  an  academic  career  in  clinical  medicine. 

Hospital  duties:  The  immediate  care  of  patients  in  the 
special  wards  and  the  private  patients  of  the  director,  assistant 
director,  and  director  of  out-patient  department.  To  carry  on 
research. 

University  duties:  Preparation  of  patients  for  the  amphi- 
theatre clinics. 

Clinical  Assistant  for  the  special  wards  and  private  patients, 
to  assist  the  residents,  especially  in  the  routine  laboratory  work. 

Residents  and  Assistant  Residents  of  the  divisions.  To  be 
appointed  for  an  indefinite  term  but  not  so  long  as  the  above, 
with  the  usual  duties  in  the  hospital,  and  to  assist  in  the  teach- 
ing of  the  clinical  clerks. 

Medical  Internes  on  the  divisions.  Two  on  each  division 
serving  for  one  year,  either  all  medicine  or  six  months  medi- 
cine and  six  months  surgery.  To  perform  the  ordinary  duties 
of  the  lower  house  staff. 

Voluntary  Assistants  to  be  appointed  by  the  director,  as 
opportunity  may  offer,  to  pursue  studies  of  problems  in  the 
special  wards. 

Laboratory  Assistants  as  may  be  required  from  time  to  time. 
At    least    one    chemical    assistant    and    one    assistant    in    the 
biological    laboratory   for    help   with  Wassermann   and  Widal 
reactions,  blood  cultures,  etc.,  will  be  necessary. 
Out-patient  department. 

Director  in  charge,  as  above. 

Assistant  visiting  physicians,  in  charge  of  division  units,  as 
above. 

13 


One  physician  in  charge  of  tuberculosis  class. 
Physicians  in  charge  of  rooms. 
Clinical  assistants  as  may  be  required. 

Administrative  force. 

One  department  secretary  and  librarian. 
One  assistant  secretary  and  librarian. 
One  medical  record  clerk. 

XI.    Estimates    of    space    required    for    educational    and 

scientific  purposes: 

Medical  amphitheatre  (2  stories).  .    2,500  sq.  ft. 

Waiting  rooms,  2  each  300  sq.  ft.  .  .        600       " 

Store  rooms 400      "         3,500  sq.  ft. 

Rooms  for  recitations  and  demon- 
strations in  Out-Patient  De- 
partment, to  be  used  by  both 
medical  and  surgical  depart- 
ments. 

One  room 600  sq.  ft. 

Two  rooms,  each  300  sq.  ft. .  . .       600      "         1,200  sq.  ft. 

Teaching  rooms  for  the  three  medi- 
cal divisions,  each  300  sq.  ft. .  .       900  sq.  ft.         900  sq.  ft. 

Library,  stackroom 1,200  sq.  ft. 

Reading  room 500      "          i,7°°  SQ-  It:- 

Students'  coat-room  for  250  stu- 
dents, about 750  sq.  ft.         750  sq.  ft. 

Students'  lunch  room 750  sq.  ft.         750  sq.  ft. 

Students'  lavatories 400  sq.  ft.         400  sq.  ft. 

Laboratories  (not  including  ward 
laboratories.  Of  this  space 
much  would  be  necessary  for 
any  first-class  modern  hospital). 

Chemical  : 

Main  laboratory 800  sq.  ft. 

Kjeldahl  room 150  " 

Distillation  room 150  " 

Balance  room 150  " 

Three     rooms     for     individual 

workers,  each  200  sq.  ft. .  .  600  " 

Store  room 150  "         2,000  sq.  ft. 


300  sq.  ft. 


electrocardio- 


240 

400 

40 


Physiological : 

Main  laboratory 
Dark    room    for 

graph 

Two  rooms,  each  200  sq.  ft. 
Developing  room 

Biological : 

Main  bacteriological  laboratory.  600  sq.  ft. 

Serological  room    240 

Thermostat  room 30 

Refrigerating  room 30 

Preparation  room 300 

Two  rooms,  each  150  sq.  ft. .  .  .  300 

Animal  room 200 

Janitor's  accommodations 

Unassigned  laboratory  space  to  be 

held  for  future  use I,5°°  sq.  ft. 

Total 


980  sq.  ft. 


1,700  sq. 
200  sq. 


ft. 
ft. 


1,500  sq.  ft. 
15,580  sq.  ft. 


Plan    of    Organization    for   the    Surgical    Clinic    in    the 
Presbyterian  Hospital 

I.  Ward  service  of  150  beds,  to  be  organized  as  follows: 
Three  service  units  of  50  beds  each,  or  of  44  beds  each, 
in  order  to  correspond  with  the  organization  of  the  medical 
service,  and  a  semi-private  ward  of  18  beds  in  3  small  wards 
of  6  beds  each.  (This  semi-private  ward  to  have  ward  food 
and  a  nurse  to  each  six  beds  under  a  head  nurse  for  the 
whole  ward.)  Each  service  unit  with  the  exception  of  the 
semi-private  ward  to  have,  besides  the  necessary  service 
rooms,  lavatories,  etc.,  additional  rooms,  as  follows: 

1.  A  laboratory  for  all  the  routine  chemical  work  of  the 
division,  adequately  equipped  for  urine,  stomach,  and  similar 
examinations,  and  of  sufficient  size  for  five  men  to  work  in  at 
one  time.      Hospital  requirement 150  sq.  ft. 

2.  An  adjoining  and  communicating  laboratory  for  micro- 
scopic examinations,  equipped  with  an  incubator,  a  stone-topped 
table  for  sputum  staining,  a  microscope  table  for  the  resident 
staff  and  another  for  the  clinical  clerks,  microscopes,  etc. 
Hospital  requirement 150  sq.  ft. 


15 


3.  A  room  for  dressings  and  teaching  sections  of  not  more 
than  20  students,    15  x  16 240  sq.  ft. 

4.  A  similar  room,  but  provided  with  small  lockers  for  10 
clinical  clerks,  15x16 240  sq.  ft. 

The  only  purely  educational  space  in  these  last  two  rooms 
is  that  for  lockers. 

5.  Retiring  room  for  friends  of    patients  on  danger  list. 

II.  Emergency  Ward. 

1.  Twenty-five  beds,  15  for  men,  10  for  women,  should  be 
placed  in  the  basement  of  the  surgical  pavilion  and  in  close 
connection  with  the  surgical  division  of  the  out-patient 
department,  in  order  to  avoid  duplication  of  plant. 

To  be  under  the  immediate  charge  of  the  resident  sur- 
geons in  rotation  during  the  day  and  night,  under  the  direction 
of  the  first  assistant  visiting  surgeon. 

2.  Admitting  offices.  In  close  connection  with  the  Emer- 
gency Ward. 

One  office 100  sq.  ft. 

Two  examining  rooms  (for  male  and  female 
patients) 300       " 

Two  waiting  rooms  (for  male  and  female 
patients) 300       ' ' 

III.  Isolation  Wards. — These  isolation  wards  should  be  in 
connection  with  the  surgical  wards  for  children.  Infected 
cases  and  erysipelas  cases  can  be  cared  for  in  the  small  sub- 
division of  the  general  wards. 

IV.  Cancer  Ward. — Twenty-four  beds  under  the  auspices 
of  the  Crocker  Fund  and  under  the  control  of  the  director 
of  the  surgical  clinic. 

V.  Private  Rooms.  —  Not  less  than  35  or  more  than  50 
should  be  provided. 

The  private  patients  of  each  member  of  the  visiting  staff 
to  be  under  the  immediate  charge  of  the  resident  surgeon 
assigned  to  that  member. 

All  private  patients  applying  at  the  hospital  should  be 
assigned  to  the  director  and  distributed  by  him,  as  he  sees  fit. 

16 


VI.  Laboratories  of  surgical  pathology  and  experimental 
surgery  should  be  close  together  and  adjacent  to  the  library 
and  Students' reading  and  study  rooms.  They  should  be  near 
the  surgical  amphitheatre  and  preferably  on  the  same  floor  as 
the  operating  room,  even  if  in  separate  buildings. 

Experimental  surgery  needs  top-light  for  operating  rooms. 
It  and  surgical  pathology,  including  surgical  bacteriology, 
will  be  under  the  charge  of  the  surgical  pathologist.  Hence 
the  necessity  of  grouping  these  departments  as  closely  as 
possible. 

The  record  room  should  also  adjoin  the  laboratories. 
If  possible,   surgical    pathology  should  connect   with   the 
main  Department  of  Pathology. 

i.  Surgical  Pathology.  Should  be  on  the  same  floor  or 
adjacent  to  operating  rooms  and  in  close  connection  with 
surgical  record  rooms. 

One  general  laboratory  room,  north  light 1,000  sq.  ft. 

Five  individual  rooms,  each  200  sq.  ft 1,000 

One  class  microscope  room 1,000 

One  record  room  for  slides,  etc 200 

Two  rooms,  photography,  including  dark  room.     300 

One  museum 600 

One  store  room 600 

Three  animal  rooms  for  guinea  pigs  and  rabbits    600 
Extra  space,  mechanics,  etc 1,000 


6,300  sq.  ft. 

2.  Surgical  Bacteriology. 

One  room  for  sterilization  and  preparation  of 

media 240  sq.  ft. 

One  preparation  room 300 

One  serological  room 240 

One  animal  room 240 

Two  individual  rooms,  each  150  sq.  ft 300 

One  thermostat  room 150 

One  refrigerating  room 150 

1,620  sq.  ft. 

3.  Experimental   Surgery. — Should  adjoin   Surgical  Path- 
ology. 

Main  operating  room  (4  tables) 500  sq.  ft. 

Four  small  operating  rooms  10  x  12 480       " 

17 


One  Directors'  room 240  sq.  ft. 

One  sterilizing  room 120       " 

Four  recovery  wards  20  x  20  (two  for  isolation).  1,600       " 

(in  animal  house  if  necessary) 
One  autopsy  room  (icebox) 300       " 

(Combine  with  Department  of  Pathology) 

One  nurses'  room  and  toilet 120       " 

One  animal  house  and  yard  in  connection  with 

other    departments    (and    possibly    with 

Rockefeller  Institute). 

Ward  for  supply  of  animals 500       " 

Yards. 

One  reception  office  for  animals  received  for 

treatment — two  or  three  rooms 450       " 

4,310  sq.  ft. 

4.  Library  and  Record  Rooms. 

Library  stack  room 1, 200  sq.  ft. 

Students'  reading  room  and  study  room 500       " 

5.  Record  Room  for  entire  surgical  department: 

Clerk's  office 200  sq.  ft. 

Stack  room 300       ' ' 

History  consulting  room 200       " 

VII.  Operating  Rooms. 

1  Amphitheatre  to  seat  150. 

4  general  operating  rooms  about  20  x  25  ft.  without  fixed 
seats  and  one  smaller  room  for  cystoscopy,  etc.  Accessory 
wash,  sterilizing,  preparation,  etherization,  toilet,  waiting 
rooms,   etc. 

No  space  is  required  for  teaching,  per  se. 

All  operations  to  be  done  between  8  a.m.  and  1  p.m. 
Ordinarily,  two,  possibly  three,  operating  rooms  running 
simultaneously.     Average  of  12  operations  each  week  day. 

VIII.  Teaching  Facilities. 

1.  Teaching  room  for  each  service  unit  as  already  specified. 

2.  A  surgical  amphitheatre  to  seat  250,  located  on  one  of 
the  lower  floors  of  the  surgical  pavilion  and  near  the  out- 
patient   department,    with    side     light,     preferably    from    the 

18 


north.      Equipped    with    projection    apparatus  and  automatic 
shutters,  radiograph  box,  blackboards,  chart  rack,  wash,  etc. 

Separate  entrance  for  students 2500  sq.  ft. 

Adjacent  to  and  communicating  with  the  amphitheatre 
must   be    three  waiting  rooms    for    patients,   each  about  300 

sq.  ft 900  sq.  ft. 

and  a  large  room  for  storage  of  charts,  models,  etc.. 400  sq.  ft. 

3.  Departmental  Library.  This  should  adjoin  the  labor- 
atory of  surgical  pathology,  as  already  specified. 

Library 1 200  sq.  ft. 

Students'   reading  and  study  rooms 500  sq.  ft. 

4.  Three  rooms  in  out-patient  department  suitable  for 
recitations  or  demonstrations,  one  capable  of  holding  60,  the 
other  30  students,  should  be  provided.  For  both  medical  and 
surgical   classes.      See  Medical  List. 

5.  A  coat  room  for  students  should  be  provided,  prefer- 
ably near  the  out-patient  department,  with  accommodations 
for  250  students.     See  Medical  List 750  sq.  ft. 

6.  Students'  lavatories  for  the  same  number  should  be 
provided,  adjacent  to  the  coat  room.      See  Medical  List. 

7.  A  lunch  room,  capable  of  serving  buffet  lunch  and  with 
some  tables  should  be  provided  for  students,  and  be  run  at  a 
small  profit  or  leased  to  a  purveyor 750  sq.  ft. 

IX.    Accommodations  for  the  Staff. 

1.  Consulting  offices  for  the  director  and  assistant  director 
should  be  provided  on  the  first  floor  of  the  surgical  pavilion, 
with  anterooms  sufficiently  large  to  accommodate  patients, 
callers  and  secretary. 

Two  consulting  rooms 480  sq.  ft. 

One  waiting  room 250  " 

Three  examining  rooms 240  " 

Two  dressing  rooms 240  " 

Two  anterooms  for  nurses  and  attendants 

One  laboratory 100  " 

Two  toilets  near  examining  rooms 

2.  Resident  staff  quarters  to  provide  for  16  men,  the  resi- 
dents each  to  have  a  study,  bedroom  and  bath ;  the  internes, 

19 


three  bedrooms  and  a  bath  for  each  division.  The  remaining 
rooms  to  be  arranged  with  a  bath  for  each  two  bedrooms  for 
voluntary  assistants  or  assistant  surgeons  who  may  be  resident. 
There  should  be  a  general  club  room,  a  reading  and  writing 
room,  and  a  common  dining  room  for  both  medical  and  sur- 
gical staffs.     See  Medical  List. 

3.  A  lunch  room,  or  accommodations  in  the  staff  dining 
room,  for  luncheon  for  the  visiting  staff,  to  be  provided  at 
cost,  should  be  planned.      See  Medical  List. 

X.  Out-Patient  Department.  Should  be  administered  by  a 
single  staff  under  the  first  assistant  visiting  surgeon  as  chief 
and    the    second  assistant  visiting  surgeon   as    deputy    chief. 

The  arrangement  and  size  of  rooms  will  have  to  be  deter- 
mined later. 

Three  rooms  for  demonstrations  and  recitations,  to  be  used 
conjointly  with  the  medical  clinic,  as  already  specified. 

XL  Facilities  desired  by  the  surgical  clinic  in  other 
departments  of  the  hospital: 

1.  X-ray  and  photographic  department.  This  department 
should  carry  on  work  for  the  whole  hospital.  For  the  special 
use  of  the  medical  and  surgical  service  there  should  be  a  room 
for  fluoroscopic  examination  and  demonstration,  with  proper 
protection.      See  Medical  List. 

Arrangements  should  also  be  made  for  prints  of  photo- 
graphs and  reduced  radiographs  for  filing  with  the  medical  and 
surgical  histories. 

2.  Department  of  physical  therapeutics  and  hydrotherapy. 
This  should  carry  on  treatment  as  ordered  both  for  ward  and 
private  patients  and  for  out-patients,  under  proper  limitations 
of  hours,  for  medical  and  surgical  services. 

3.  Social  service  department.  This,  again,  should  assist 
both  medical  and  surgical  services,  in  hospital  and  out-patient 
department,  with  a  proper  system  of  reference  and  report.  A 
special  system  of  following  up  surgical  cases  to  be  organized. 
See  Medical  Lists. 

4.  General  admitting  offices. 

20 


XII.  Personnel  of  Staff  and  Duties.  The  organization  of 
the  staff  in  the  surgical  clinic  must  differ  essentially  from  that 
proposed  for  the  medical  clinic,  on  account  of  the  double 
work  in  the  wards  and  the  operating  rooms.  In  the  medical 
clinic  the  entire  teaching  and  treatment  can  be  done  on 
rounds.  In  the  surgical  clinic  both  rounds  and  operating  are 
necessary. 

The  most  important  thing  in  conducting  a  surgical  clinic 
is  to  provide  for  systematic  and  efficient  service  in  the  oper- 
ating rooms.  The  technique  should  be  simple  and  consistent 
and  the  hours  regular. 

If  three  distinct  divisions  were  organized  in  the  surgical 
clinic  there  would  be  three  distinct  groups  of  operators,  which 
would  bid  fair  to  demoralize  an  operating  room  staff  or  call 
for  a  much  larger  and  more  expensive  one.  Furthermore,  the 
fitness  of  certain  surgeons  for  certain  lines  of  work,  especially 
operation,  is  more  emphasized  than  in  the  case  of  physicians. 

In  fact,  both  theoretically  and  practically  it  is  found  best 
to  organize  a  surgical  clinic  upon  a  graded  basis. 

A.    Visiting  Staff. 

i.    Director,  the  Professor  of  Surgery. 

Hospital  duties:  General  supervision  of  the  entire  service; 
immediate  supervision  of  his  own  patients  in  wards  and  private 
rooms;  operations;  consulting  rounds  with  each  associate 
surgeon,  staff  and  clerks  of  each  service  unit  once  a  week; 
consultations  in  out-patient  department  once  a  week.  Allowed 
private  consulting  practice  in  hospital,  and  consultations 
outside  after  5  p.m. 

University  duties:  General  supervision  of  department. 
Operative  clinic  three  times  a  week;  clinical  lecture  twice  a 
week  and  didactic  lecture  once  a  week;  departmental  seminar 
once  in  two  weeks;  instruction  clinical  clerks. 

2.  Visiting  Surgeon  and  Assistant  Director,  Associate  Pro- 
fessor of  Surgery. 

Hospital  duties:  Substitute  for  director;  immediate  super- 
vision of  one  service  unit  and  of  his  private  patients;  rounds 
in  his  own  wards  daily  and  of  emergency  ward  once  a  week; 
operations    3    days    a    week;    consultation    hour    out-patient 

21 


department  once  a  week.     Allowed  private  consultation  prac- 
tice in  hospital  and  consultations  outside  after  5  p.m. 

University  duties:  Assistant  in  administration  of  depart- 
ment; three  didactic  lectures  a  week  3d  year;  one  clinical 
lecture  4th  year.      Instruction  of  clinical  clerks  on  rounds. 

3.  First  Assistant  Visiting  Surgeon,  Assistant  Professor  of 
Surgery. 

Hospital  duties:  Immediate  supervision  of  one  service  unit 
and  of  his  private  patients;  rounds  in  his  service  unit  daily  ; 
operations  three  days  a  week.  Substitute  for  visiting  sur- 
geon. Out-patient  department  consultation  once  a  week. 
Allowed  outside  practice. 

University  duties :  Instruction  of  clinical  clerks  on  rounds ; 
charge  of  class  in  experimental  surgery;  lectures  and  confer- 
ences on  selected  subjects. 

4.  Second  Associate  Visiting  Surgeon,   Associate  in  Surgery. 
Hospital  duties:  Same  as  first  associate. 

University  duties:  Instruction  of  clinical  clerks  on  rounds; 
4  recitations  3d  year. 

5.  Third  Associate   Visiting  Surgeon,   Associate  in  Surgery. 
Hospital  duties:  General  substitute  inwards  and  operating 

rooms.      Consultation  hour,   out-patient  department,   twice  a 
week;  immediate  supervision  of  children's  ward. 

University  duties:  Four  recitations  3d  year;  instruction 
of  clinical  clerks. 

6.  First  Assistant  Visiting  Surgeon  and  Visiting  Surgeon  to 
the  Out-Patient  Department,  Instructor  in  Surgery. 

Hospital  duties:  Chief  of  surgical  out-patient  department. 
Substitute  for  third  associate.  Limited  number  of  operations. 
Ward  rounds.     Allowed  private  patients. 

University  duties:  Instruction  of  clinical  clerks  in  minor 
surgery  and  in  wards. 

7.  Second  Assistant  Visiting  Surgeon,  Instructor  in  Surgery. 
Hospital  duties:     Deputy    chief,    out-patient    department; 

limited  operation  and  ward  service;  allowed  private  patients. 
University  duties:    Instructor   of  clinical    clerks  in   minor 
surgery  and  in  wards. 

22 


8.  Third  Assistant  Visiting  Surgeon,   Instructor  in  Surgery. 
Hospital     duties:       Assistant     surgical     pathologist     and 

recorder. 

University  duties:  Overseer  of  clinical  clerks. 

9.  Fourth  Assistant  Visiting  Surgeon,  Instructor  in  Surgery. 
Hospital  duties:   Assistant  recorder.    2d  assistant  surgical 

pathologist. 

University  duties:  Overseer  of  clinical  clerks. 

10.  Fifth  Assistant  Visiting  Surgeon,  Instructor  in  Surgery. 
Hospital  duties:  Assistant   recorder,    3d  assistant  surgical 

pathologist. 

University  duties:  Overseer  of  clinical  clerks. 

11.  Sixth  Assistant  Visiting  Surgeon  and  Visiting  Surgical 
Facteriologist,   Instructor  in  Surgery. 

Hospital  duties:  In  charge  of  laboratory  surgical  bacteri- 
ology. 

University  duties:  Instructor  of  clinical  clerks. 

12.  Visiting  Surgical  Pathologist,  Assistant  Professor  of 
Surgery. 

Hospital  duties:  Director  of  laboratories  of  surgical  path- 
ology and  experimental  surgery;  in  charge  of  surgical  library. 
Allowed  special  patients  in  wards  and  private  rooms. 

University  duties:  As  above,  and  in  charge  of  courses  for 
second  year  students. 

13.  Consulting    Facteriologist,    Professor    of    Bacteriology. 
All  members  of  visiting  staff  will  be  expected  to  do  research 

work. 

B.    Resident  Staff.       Salaried.     Indefinite  appointments. 

1.  Chief  Resident  Stag  eon. 

Duties:  In  charge  of  the  private  patients  of  the  director; 
assist  him  in  the  operating  room;  prepare  his  general  clinics; 
chief  admitting  officer;  research. 

2.  First  Assistant  Resident  Surgeon. 

Duties:  In  charge  of  one  of  the  service  units,  under  the 
visiting  surgeon;  assist  him  and  care  for  his  private  patients; 
prepare  clinics;  research. 

23 


3.  Second  Assistant  Resident  Surgeon. 

Duties:  In  charge  of  one  of  the  service  units;  under  the 
first  associate  surgeon;  assist  him  and  care  for  his  patients; 
research. 

4.  Third  Assistant  Reside/it  Surgeon. 

Duties:  In  charge  of  one  of  the  service  units;  under  the 
second  associate  surgeon,  and  assist  him  and  care  for  his 
private  patients;  research. 

5.  Resident  Bacteriologist. 

Duties:  In  the  laboratory  of  surgical  bacteriology  under 
the  visiting  surgical  bacteriologist;  research.  Instructor 
of  clinical  clerks. 

The  resident  staff,  with  the  exception  of  the  resident 
bacteriologist,  besides  their  clinical  duties,  will  have  the  oppor- 
tunity to  work  in  the  laboratories  and  also  will  be  expected  to 
cooperate  in  the  teaching  of  the  clinical  clerks. 

They  shall  have  charge  of  the  emergency  ward  for  speci- 
fied hours  of  the  day  and  act  as  admitting  officers  under  the 
chief  resident. 

6.  House  Staff.  Not  salaried.  There  shall  be  nine 
internes,  three  for  each  service  unit  with  assignment  of  duties 
in  the  emergency  ward. 

Duties:  Same  as  present  assistant  members  of  house  staff. 

7.  Clinical  clerks.  There  shall  not  be  more  than  30  clinical 
clerks  in  the  entire  surgical  clinic. 

Volunteer  assistants  or  scholars  may  be  appointed  from 
time  to  time  by  the  director  to  conduct  research  or  help  in 
the  laboratories. 

Out-Patient  Department.  Sufficient  assistant  surgeons  and 
clinical  assistants. 

Plan  of  Organization  for  the   Pathological   Department 
in  the   New  Presbyterian  Hospital. 

Hospitals  differ  according  to  their  material  and  according 
to  the  character  of  their  staff,  but  it  may  safely  be  said  that 
the  difference  in  the  character  of  the  staff  far  outweighs  the 
difference  in  the  material.  Indeed,  the  material  depends 
greatly   upon    the    interest    and    skill    shown    by   the  visiting 

24 


physicians  in  the  study  of  some  particular  type  of  disease — a 
thing  which  is  made  very  evident  in  the  case  of  the  hospital  of 
the  Mayo  Brothers  at  Rochester.  It  becomes  quite  obvious 
from  the  examination  of  the  work  done  in  the  hospitals  which 
have  a  relatively  small  staff  and  which  are  not  connected  with 
a  teaching  institution,  that  the  work  ends  with  the  estab- 
lishment of  a  reasonably  satisfactory  diagnosis  or  indication 
for  operation,  unless  some  especially  enthusiastic  attending 
physician  becomes  interested  in  a  particular  group  of  cases. 
The  work  of  such  a  hospital  must  average  about  fourth  class, 
not  necessarily  so  far  as  the  individual  patient  is  concerned 
but  as  compared  with  the  possibilities  of  extending  the  results 
obtained  to  the  general  medical  world. 

To  attain  anything  like  first  class  work,  more  than  the 
mere  routine  treatment  of  patients  must  be  aimed  at,  and  we 
cannot  consider  any  hospital  work  first  class  unless  it  succeeds 
finally  in  making  some  addition  to  the  sum  of  human  knowl- 
edge concerning  the  diseases  which  are  brought  to  the  atten- 
tion of  the  staff.  A  first  class  hospital,  therefore,  requires  a 
staff  of  a  size  which  might  seem  at  first  sight  extravagantly 
great,  but  which  is  absolutely  necessary  in  order  to  accomplish 
the  enormous  amount  of  work  for  which  they  have  opportunity. 

If  this  is  true  in  connection  with  the  medical  and  surgical 
divisions,  it  is  more  than  ever  true  of  the  pathological  depart- 
ment of  the  hospital,  for  notwithstanding  the  fact  that  we 
cannot  too  highly  estimate  the  value  of  purely  clinical  obser- 
vations as  far  as  the  welfare  of  the  patient  is  concerned,  the 
actual  contribution  to  our  knowledge  of  disease  comes  in  this 
age  chiefly  from  the  application  of  laboratory  methods  to  the 
patients.  A  pathological  laboratory  of  the  hospital,  there- 
fore, which  contents  itself  with  the  routine  examination  of 
tissues  and  excreta  from  the  patients,  is  shamefully  perfunctory 
and  goes  far  to  drag  down  the  standard  of  work  throughout 
the  hospital.  It  is  recognized  by  every  broadminded  person 
of  the  present  day  that  in  order  to  clear  up  the  problems  pre- 
sented by  these  diseased  patients  as  well  as  to  carry  out  the 
mere  necessary  routine,  it  is  essential  to  have,  in  immediate 
connection  with  the  hospital,  laboratories  fully  equipped  with 
facilities  and,  above  all,  with  men,  for  the  investigation  of  the 
most  varied  questions.      This  essential,   in  so  far  as  the  men 

25 


are  concerned,   can  be  fulfilled   only  by  such  an  alliance  with 
the  University  as  has  been  entered  upon. 

The  men  are  perfectly  available  at  the  present  moment, 
and  the  material  need  consists  only  in  the  establishment  of 
adequate  laboratories  for  their  work,  in  the  hospital.  If  they 
are  compelled  to  carry  out  the  investigative  parts  of  the  work 
in  a  far  distant  institution  and  the  routine  parts  in  the  hospital, 
the  whole  thing  will  become  perfunctory  as  far  as  the  patients 
are  concerned.  It  seems  that  this  can  be  avoided  only  by  the 
establishment  of  the  whole  pathological  department  in  the 
hospital — a  plan  which  involves,  of  course,  a  temporary  sepa- 
ration of  the  medical,  surgical  and  pathological  departments 
from  the  rest  of  the  school.  This  separation  should  not  be  per- 
manent, however,  and  would  havefar  less  injurious  influence  than 
a  continuation  of  the  present  division  of  the  pathological  work. 

The  medical  and  surgical  institutes  are  planned  to  be  com- 
plete in  so  far  as  the  clinical  pathology  is  concerned;  but 
when  problems  arise  there  which  demand  experimental  study 
of  animals,  it  is  far  more  convenient  to  perform  such  experi- 
ments in  rooms  separated  from  the  ward  buildings, — and  this 
should  be  arranged  for  in  the  pathological  department.  For 
practical  reasons  this  department  must  also  hold  itself  respon- 
sible for  the  examination  of  tissues  excised  from  patients 
either  in  the  medical  or  surgical  clinics.  Since  there  is  a  very 
great  amount  of  such  material  from  numerous  surgical  oper- 
ations, it  is  necessary  to  establish  a  separate  staff  of  surgical 
pathologists;  but  it  should  be  especially  emphasized  that  this 
work  should  be  done  under  the  supervision  of  the  director  of 
the  laboratory  of  general  pathology.  This  is  because  it  fol- 
lows certain  narrow  lines,  and  experience  shows  that  the 
results  deteriorate  very  rapidly  if  it  be  separated  from  work  in 
general  pathology.  The  laboratories  of  surgical  pathology 
should  therefore  be  built  either  in  the  general  pathological 
laboratory  or  in  immediate  connection  with  it. 

After  the  death  of  the  patient,  the  further  study  of  the  case 
falls  into  the  domain  of  the  pathological  department.  Complete 
arrangements  must  therefore  be  made  for  the  performance  of 
autopsies  and  the  preservation  of  records  and  of  specimens. 
As  a  continuation  of  this,  however,  the  problems  suggested 
by  the  autopsies  must  be  studied  by  experimental  methods. 

26 


All  of  this  is  legitimately  the  function  of  the  pathological 
department  in  the  hospital.  For  the  purpose  of  education 
and  instruction,  there  is  required  in  addition  a  working  labor- 
atory for  the  students,  a  small  demonstration  room  and  some 
smaller  rooms  for  individual  workers. 

Buildings  for  the  pathological  department  may  be  planned 
as  follows: 

It  is  desirable  to  concentrate,  as  far  as  possible,  all 
infected  material  such  as  is  derived  from  autopsies  and  such 
as  is  used  for  gross  pathological  demonstration,  in  one  or  at 
most  two  rooms.  For  this  purpose  the  morgue,  with  its  cold 
storage  apparatus,  and  a  large  simple  autopsy  room  would  be 
sufficient.  This  combination,  together  with  the  rooms  for 
experimental  work  and  the  room  or  rooms  in  which  operative 
technique  is  taught,  should  be  on  the  top  floor  of  the  building, 
and  all  should  be  furnished  with  generous  skylights  as  well  as 
lateral  lights.  There  should  be  a  service  elevator  connecting 
the  top  story  with  the  corridor  in  the  basement  for  the  trans- 
portation of  animals,  bodies  and  freight.  It  should  be  so 
arranged  as  to  be  readily  kept  quite  clean. 

The  autopsy  room  should  be  a  perfectly  plain,  square  room, 
with  the  largest  possible  windows  and  with  the  largest  possible 
skylight.  Its  walls,  ceiling  and  floor  should  be  smooth  as 
possible  and  composed  of  tile,  concrete,  opaque  glass  or  some 
such  substance  capable  of  being  easily  cleaned.  The  angles 
of  walls  and  floor  should  be  round.  There  should  be  abundant 
artificial  (electric  arc)  lights  in  the  room — one  or  more  over 
each  of  four  autopsy  tables.  The  floor  should  be  so  arranged 
as  to  readily  drain  away  any  fluids  which  are  spilt  on  it  so  that 
the  room  could  be  swept  out  with  a  hose.  There  should  be 
absolutely  no  furniture  except  the  tables  and  sinks.  Of  these 
there  should  be  several  hand  basins  and  two  or  more  large 
porcelain  sinks  with  drain  boards,  standing  at  a  low  level. 
The  plumbing  should  be  everywhere  exposed.  The  autopsy 
tables  should  be  very  plain,  possibly  of  the  type  installed  in 
the  new  laboratory  of  Bellevue  Hospital. 

All  bodies  from  the  hospital  should  be  brought  to  the 
morgue  in  the  top  floor  of  the  laboratory,  and  there  should  be 
a  room  set  aside  for  their  reception  which  could  also  serve  as 
the  room  to  which   undertakers  must  come   for  them.      It  is 

27 


especially  desirable  that  this  room  should  be  under  the  imme- 
diate supervision  of  the-  laboratory  authorities,  who  could 
thus  form  an  intelligent  idea  of  the  proportion  of  autopsies 
obtained.  This  room  should  be  provided  with  lockers  for  the 
patients'  clothes,  etc.  One  side  might  constitute  the  cold 
storage  plant  composed  of  ten  or  twelve  compartments,  with 
a  door  at  each  end  so  that  the  body  could  be  put  in  at  one  end 
and  taken  out  either  there  or  at  the  other  end.  The  elevator 
shaft  from  the  basement  and  other  corridors  should  open  con- 
veniently into  this  room.  The  opposite  ends  of  the  cold 
storage  compartments  should  open  into  a  room  adjoining  the 
autopsy  room  in  which  the  body  could  be  weighed,  prepared 
before  the  autopsy  and  transported  to  and  from  the  autopsy 
room  on  a  wheeled  carriage.  This  room  should  be  large 
enough  for  such  a  wheeled  stretcher  to  turn  around  and  should 
open  by  a  wide  door  into  the  autopsy  room. 

The  autopsy  room  should  be  used  for  the  demonstrations  in 
gross  pathology,  so  that  infected  material  need  never  leave 
this  room  except  to  be  burnt. 

Upon  this  floor  there  should  also  be  a  small  room  supplied 
with  sufficient  apparatus  for  the  immediate  examination  of 
materials  from  autopsy,  making  frozen  sections,  museum  speci- 
mens, etc  This  room  might  also  contain  accommodation  for 
autopsy  instruments,  gowns,  gloves,  fixing  fluids,  jars,  etc. 
On  this  account  it  cannot  be  very  small.  It  would  be  desir- 
able to  have  somewhere  in  the  building  a  room  in  which  those 
performing  autopsies  could  change  their  clothes  and  take  a 
bath,  and  this  could  be  placed  to  greatest  advantage  quite 
near  the  autopsy  room. 

The  rest  of  the  top  floor  should  accommodate  the  greater 
number  of  the  rooms  for  experimental  work  since  for  this  pur- 
pose skylights  are  so  valuable.  For  the  teaching  of  students 
in  surgical  technique,  Dr.  Blake's  specifications  are  referred 
to.  Animal  rooms  for  the  animals  in  immediate  use  should  be 
built  into  this  floor.  There  should  be  as  many  small  operating 
rooms  as  possible  to  accommodate  those,  whether  of  medical, 
surgical  or  pathological  departments,  whose  problem  requires 
experimental  study  of  animals.  These  rooms  need  not  be  very 
large — indeed  most  of  them  should  be  quite  small— not  more 
than  ten  by  fifteen  feet,  but  there  should  be  one  or  two  larger 

28 


rooms  in  which  the  more  elaborate  apparatus,  kymographs, 
etc.,  could  be  properly  set  up.  They  should  have  walls  of 
wood  upon  which  apparatus  could  be  hung,  vertical  and  cross 
bars  of  iron  for  the  same  purposes,  a  sink,  a  table,  a  window 
bench  and  a  cabinet  for  books,  instruments,  etc.,  large  win- 
dows, skylights  and  abundant  electric  light  and  gas.  Not 
less  than  ten  of  such  rooms  should  be  planned  for,  exclusive  of 
those  for  teaching  surgical  technique.  There  should  also  be  a 
room  for  sterilizing  dressings  and  for  the  assistant,  in  which 
to  keep  his  materials  and  apparatus. 

The  next  two  floors  should  be  planned  to  accommodate  the 
work  in  pathological  histology,  chemistry,  bacteriology  and 
such  physiological  work  as  does  not  require  overhead  light. 
Here,  too,  might  be  lodged,  if  possible,  the  laboratories  for 
surgical  pathology  according  to  Dr.  Blake's  specifications. 
Since  these  specifications  involve  large  teaching  laboratories, 
it  may  be  difficult  to  arrange  for  them  all  in  the  pathological 
laboratory. 

If  surgical  pathology  is  to  be  added  to  the  Pathology  Build- 
ing— 7,620  sq.  ft. — required  by  Dr.  Blake  in  his  estimate,  it 
could  easily  fit  into  a  fifth  floor;  an  extra  floor  to  be  added. 

There  should  be  a  laboratory  room  for  the  director  of  the 
department  with  a  toilet  room,  an  anteroom  for  the  reception 
of  those  who  wish  to  consult  him,  and  a  small  room  for  the 
secretary.  For  the  assistant  director  there  should  be  a  similar 
laboratory  room  with  anteroom.  The  other  assistants  should 
each  have  a  small  laboratory  room  and  there  should  be  several 
similar  rooms  to  be  available  for  voluntary  workers.  In 
addition  there  should  be  two  larger  rooms  for  the  accommo- 
dation of  miscellaneous  students  and  other  workers.  The 
individual  rooms  should  be  small  with  a  large  window,  window 
bench,  sink,  table,  and  a  cabinet  for  slides,  books,  apparatus, 
etc.  There  should  be  as  many  as  possible  of  these,  and  their 
small  size,  which  insures  privacy,  would  aid  in  this  respect. 
The  other  requirements  on  this  floor  are  a  room  for  the  sten- 
ographer, with  arrangements  there,  or  in  a  separate  fireproof 
room,  for  the  preservation  of  records,  index,  catalogue,  etc.,  a 
room  for  the  artist,  who  forms  an  integral  part  of  the  depart- 
ment, and  a  room  of  rather  larger  size  for  the  technician  where 
most  of  the  section  cutting,  staining,  etc.,  must  be  carried  out. 

29 


There  must  be  Oil  each  floor  a  small  store-room  for  the  mate- 
rials which  are  in  current  need,  and  a  room  for  the  janitor  in 
which  to  keep  brooms,  mops  and  refuse,  with  sinks  and  clean- 
ing apparatus  in  general.  There  must  also  be  a  toilet  room  on 
each  floor. 

On  one  floor  of  the  building  there  should  be  a  room  where 
the  staff  might  take  their  luncheon,  or  provision  should  be 
made  for  them  with  the  visiting  staff.  Another  necessary 
feature  is  a  workshop  fitted  with  a  carpenter's  bench  and  such 
simple  machinery  as  a  lathe,  grinding  apparatus,  etc.,  for  the 
repair  of  instruments.  A  band  saw  for  the  preparation  of 
sections  of  bone  is  an  apparatus  found  in  every  European  lab- 
oratory and  is  essential  for  the  study  of  bones.  This  could 
be  set  up  in  the  workshop. 

The  bacteriological  and  chemical  divisions  need  not  be 
elaborate,  but  must  be  adequate  for  the  work  of  the  autopsies. 
There  must  be  a  room  for  the  preparation  and  sterilization  of 
media,  and  two  rooms  for  the  actual  bacteriological  work, 
with  an  animal  room  for  rabbits,  etc.,  and  a  small  store-room 
for  glassware. 

The  chemical  laboratory  should  not,  as  is  usually  the  case, 
be  in  the  form  of  one  large  room  with  apparatus  common  to 
all  workers,  but  rather  in  three  small  individual  laboratories 
fitted  up  in  the  usual  wTay,  with  a  small  balance  room  and  at 
one  side  a  small  but  well  ventilated  Kjeldahl  room.  For  both 
bacteriological  and  chemical  divisions  there  should  be  space 
for  electric  motors  with  centrifuge,  shaking  machines,  etc. 

Upon  the  second  floor  the  library  of  the  department  could 
be  most  conveniently  lodged.  It  should  be  constructed  like 
that  of  the  Rockefeller  Institute,  with  one  large  reading  room 
with  stack  room  for  current  journals,  also  to  be  used  as  read- 
ing room.  Each  room  should  be  provided  with  several  small 
tables  and  sufficient  light. 

The  first  floor  should  accommodate  the  teaching  labora- 
tory. This  should  be  large  enough  for  one  hundred  and 
twrenty-five  (125)  students  and  should  be  arranged  at  the  end 
of  the  building  so  that  the  students  might  face  the  light  either 
way.  It  must  be  provided  with  tables — or  better,  with  desks 
containing  lockers.  There  must  be  a  platform  about  a  foot 
high   with   a  blackboard   and   a  table   for  the   lecturer.      This 

3° 


laboratory  should  be  very  accessible  from  the  main  corridor 
and  should  give  ready  entrance  into  a  small  adjacent  amphi- 
theatre room  which  could  be  darkened.  In  this  room  there 
should  be  seats  for  one  hundred  and  twenty-five  (125)  students, 
so  arranged  as  to  allow  the  best  view  of  lantern  slides  pro- 
jected on  the  screen.  The  rest  of  the  first  floor  should  be 
occupied  by  the  museum  except  for  a  small  preparation  room 
immediately  adjacent  to  the  large  laboratory,  and  a  storeroom 
for  students'  materials.  The  museum  should  be  arranged  in 
the  manner  of  those  in  the  large  hospitals  abroad  and  should 
be  easily  darkened.  Adjoining  it  there  should  be  a  small 
preparation  room  for  the  mounting,  labeling  and  preparation 
of  specimens. 

In  the  basement  there  should  be  dry  storerooms  of  the 
greatest  possible  extent  provided,  in  some  places  with  shelves 
upon  which  specimens  could  be  stored — in  other  places  left 
vacant.  There,  too,  should  be  the  rooms  for  photographic 
apparatus,  with  dark  rooms  and  other  accessories.  At  the 
door  of  the  service  elevator,  on  one  side,  should  be  a  room  for 
undertakers,  with  a  wide  door  to  the  outside,  approached  by 
the  road.  On  the  other  side  of  this  elevator  there  should  be 
a  similar  room  for  the  reception  of  express  and  freight  parcels. 
At  the  foot  of  the  passenger  elevator  and  stairs  there  should 
be  coat  and  washrooms  for  students.  Some  rooms  in  the 
basement  should  be  retained  for  the  setting  up  of  such  heavy 
apparatus  as  the  Buchner  press,  and  it  is  important  here,  as 
elsewhere  in  the  laboratory,  that  there  should  be  unassigned 
space  wherever  possible,  because  one  cannot  foresee  the  chang- 
ing trend  of  pathological  work  even  for  a  few  years. 

The  construction  of  the  building  should  be  much  like  that 
of  the  Rockefeller  Institute,  with  central  longitudinal  corri- 
dors. The  stairs  and  passenger  elevator  should  be  placed 
somewhere  near  the  centre  of  the  building. 

Stock  animals  and  many  convalescent  animals  must  be  kept 
in  a  small  separate  building  with  a  yard  or  runway.  It  would 
be  desirable,  if  possible,  to  enter  into  cooperation  with  the 
Rockefeller  Institute  in  this  regard  so  that  the  stock  animals 
could  be  kept  together.  Otherwise,  a  building  separated  into 
small  rooms,  like  that  at  present  on  the  roof  of  the  College  of 
Physicians  and  Surgeons,  could  be  built  along  the  river  edge 

31 


of  the  lot.  This  end  of  the  lot  seems  also  the  most  desirable 
situation  for  the  whole  pathological  laboratory,  because  it 
requires  unobstructed  light,  and  because,  being  lower  than 
the  surgical  building  itself  would  not  obstruct  its  light. 
Indeed,  it  would  be  possible  to  build  the  basement  below  the 
level  of  the  cliff  and  thus  still  further  reduce  the  height  of  the 
building. 

Estimate    of    Space    Required    for    Pathological 
Department 

FOURTH  FLOOR 

Autopsy  room,  35  x  40 1,400 

Preparation  room  for  bodies,  14  x  15 210 

Small  laboratory  near  autopsy  room,  15  x  16 240 

Cold  storage,  7x18 126 

Service  elevator,  8x6 64 

Undertaker's  room,  14x15 210 

Bath  and  toilet,  15  x  10 150 

Two  animal  rooms,  14  x  15  =  210 420 

Ten    small    operating  and    experimental    rooms, 

10x15 1,500 

Two  kymograph  rooms,  16  x  17 544 

4,864 
Experimental  surgery  as  specified  by  Dr.  Blake.  2,480 

7,344 
Remainder,   unassigned 656     8,000 

This  would  require  a  building  of  at  least 
40  x  200  ft. 

THIRD  FLOOR 

Director's  laboratory,  15  x  20 300 

Director's  anteroom,  12x15 I^>° 

Secretary,  15  x  10 150 

Assistant  Director's  laboratory,  15  x  20.  .  .  .     300 

Assistant  Director's  anteroom,  15x12 180 

Associate   Professor 15x20] 

Assistant  Professor 15  x  20 

Associate 15x20 

Associate 15  x  20 

Instructor 15  x  20 

Instructor 15  x  20 

Assistant 15x20 

Assistant 15  x  20 

32 


150X  8=  1,200 


Four  other  individual  rooms,  15  x  10 600 

Two  larger  rooms,  is  x  25  (375) 750 

Assembly    room     for    seminar    and     small 

classes,   20  x  30 600 

Stenographer's  room,  20  x  1  2 240 

Record  room,  15x10 150 

Artist's  room,  20  x  12 240 

Technician's  room,  20  x  15 300 

Two  storerooms,  10x12 240 

Two  janitor's  rooms,  10x15 300 

Two  toilet  rooms,  10x15    300 

Lunch  room  for  staff,  18  x  20 360 

Workshop,  18  x  20 360 

Unassigned  space 1, 250 

8,000 
SECOND  FLOOR 
Bacteriological  Laboratory 

Media  and  sterilizing  room,  14  x  15 210 

Bacteriologist's  room,  20  x  15 300 

Bacteriological  work  room,  18x15 27° 

Animal  room,  14  x  15 210 

Store  room,  10x12 1 20 

Chemical  Laboratory 

Five  individual  laboratories,  12x15 9°° 

Kjedahl  room,  10  x  12 120 

Balance  room,  10  x  12 120 

Chemical  store  room,  10x12.... 120 

Library,  30  x  40 1 ,  200 

Journal  room,  30  x  20 600    4, 1 70 

Unassigned  space  available  for  extension  of 

these  two  departments 3)830 

8,000 
FIRST  FLOOR 

Teaching  laboratory,  40  x  70 2,800 

Demonstration  room,  25  x  30 750 

Preparation  room,  to  x  15 150 

Store  room,  10  x  15 150 

Museum,  40  x  100 4,000 

Museum  preparation  room,  10x15 I5° 

8,000 
33 


BASEMENT 

Ten  store  rooms,  14x15 210    2, 100 

Photographic  room,   15  x  20 300 

Darkroom,   10x12 120 

Priming  room,  15x14 210       630 

Undertaker's  room,  18  x  20 360 

Students'  coat  room,  20  x  30 600 

"         wash    "        20  x  20 400    1,360 

Freight  room,  20  x  20 400 

Unassigned  space 3,510 

8,000 

Animal  house 5,000 

Janitor,  10x12 120 

Food  and  bath  room,  10x15 150 

Autopsy  room  (with  icebox),  20  x  15 300 

Four  recovery  wards,   20  x  20 i,Coo 

Recapitulation  of  Space 
Medical  Clinic 

Teaching  rooms 4,400  sq.  ft. 

Library 1,700       " 

Laboratories 6,380       "  12,480  sq.  ft. 

Surgical  Clinic 

Teaching  rooms 4,800  sq.  ft. 

Library I,7°o       " 

Laboratories 12,230       "  18,730  sq.  ft. 

Pathological  Department 

Teaching  rooms 9,840  sq.  ft. 

Library 1,800       " 

Laboratories 25,880       "  37,520  sq.  ft. 

Rooms  for  General  Use 
Three    teaching    rooms    in     Out- 

Patient  Department 1,200  sq.  ft. 

Students'  coat  rooms,  lunch  room 

and  lavatories 1,900      " 

Animal  House 7, 170      "  10,270  sq.  ft. 

34 


The  foregoing  plans  for  the  organization  of  the  Presby- 
terian Hospital  as  a  university  hospital  would  hold  good  in  the 
main,  whether  the  medical  school  be  adjacent  to  the  hospital 
or  for  a  time  remain  separate  from  it.  The  reasons  for  the 
concentration  of  the  work  of  the  departments  of  medicine  and 
surgery  in  the  hospital  have  already  been  set  forth,  and  the 
maintenance  of  the  work  of  the  surgical  research  laboratories 
is  specifically  designated  to  be  supported  by  the  gift  of  Mr. 
Harkness  as  a  part  of  the  work  of  the  Presbyterian  Hospital. 
The  plan  presented  for  the  Department  of  Pathology  looks 
toward  the  creation  of  a  pathological  institute  completely 
equipped  for  hospital  work  and  for  education  and  research. 
With  the  exception  of  the  institute  which  has  just  been  erected 
as  part  of  the  new  Bellevue  Hospital  in  New  York,  such  com- 
plete institutes  have  not  existed  in  the  United  States.  They 
are,  however,  essential  parts  of  all  newer  hospitals  in  Germany, 
whether  university  hospitals  or  otherwise. 

A  large  part  of  the  work  to  be  carried  on  in  the  special 
building  thus  planned  for  is  hospital  work  and  must  be  kept 
on  hospital  ground.  An  example  of  such  work  would  be  that 
which  has  to  do  with  the  handling  of  bodies  of  those  who  die 
in  the  hospital.  The  research  and  teaching  will  be  so  inti- 
mately connected  with  the  utilization  and  study  of  this  material 
that  the  Committee  is  unanimous  in  opinion  that,  even  if  the 
college  should  be  situated  adjacent  to  the  hospital,  it  would  be 
the  height  of  unwisdom  to  maintain  any  portion  of  the  patho- 
logical department  in  a  separate  building  on  college  ground. 

The  Committee  is  still  unanimously  in  favor  of  the  principle 
which  was  presented  to  the  medical  faculty  by  another  com- 
mittee on  October  17,  1910:  "  That  there  should  be  no  separa- 
tion of  laboratory  work  and  clinical  work,  and  that  the  first 
two  years  of  the  curriculum  should  not  be  separated  from  the 
last  two  years."  The  Committee  would,  therefore,  urge  that 
every  effort  should  still  be  made  to  unite  to  the  new  Presby- 
terian Hospital  a  new  College  of  Physicians  and  Surgeons;  and 
in  support  it  would  again  call  your  attention  to  your  own 
criticism  of  January  19,  1910:  "That  the  work  of  the  medical 
faculty  must  always  be  hampered  and  limited  until  an  appro- 
priate physical  equipment  is  provided  for  it."  Should  it  be 
possible  to  rebuild  the  College  in  proximity  to  the  Presbyterian 

35 


Hospital,  the  rooms  for  general  use  specified  in  the  recapitu- 
ion  of  space  couflJTtte  provided  in  the  college  buildings. 
In  addition,  the  Committee  begs  to  call  your  attention  to 
opportunity  for  making  the  Vanderbilt  Clinic,  with  its 
bred  income  from  endowment,  a  part  of  the  new  hospital. 
:om  the  standpoint  of  the  college  it  is  most  important  that 
le  special  branches  represented  in  the  Vanderbilt  Clinic  be 
>t  divorced  from  general  medicine  and  surgery.  On  the 
|er  hand,  the  Vanderbilt  Clinic,  with  its  large  clientele,  and 
endowment,  would  be  a  most  valuable  asset  for  the  Presby- 
:rian  Hospital.  It  seems  to  the  Committee  that  an  arrange - 
lent  might  be  made  whereby  the  contribution  by  the  University 
of  the  Vanderbilt  Clinic  might  be  considered  an  adequate  com- 
pensation in  lieu  of  rental  for  the  teaching  facilities  desired 
by  the  University  in  the  pathological  department  of  the 
hospital.  The  teaching  rooms  for  medicine  and  surgery  should 
be  located  in  the  new  Vanderbilt  Clinic,  and  student's  coat- 
rooms,  etc.,  would  belong  here  or  in  the  college  buildings, 
were  they  adjacent. 

In  addition  to  the  requests  for  space  for  the  departments 
already  specified,  the  Committee  believes  that  a  children's 
service  of  fifty  beds  should  be  provided  in  the  new  hospital, 
arranged  virtually  as  one  of  the  medical  service  units  and  con- 
taining a  similar  teaching  room.  Beyond  this,  should  any 
special  branches  be  provided  for  in  the  plans  made  by  the 
Managers  of  the  Presbyterian  Hospital,  a  neurological  service 
of  forty-four  beds,  one  service  unit,  with  a  similar  teaching 
room,  should  be  the  first  to  have  consideration. 

Respectfully  submitted, 

Samuel  W.    Lambert 
Joseph  A.  Blake 
Theodore  C.  Janeway 
W.  G.   MacCallum 
W.   T.   Longcope 


36 


COLUMBIA   UNIVERSITY 


This  l>ook  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 

as  provided  by  the  rules  of  the  Library    or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE   DUE 

-  r 

L 

!  -<-v  .- 

JUL  31 

1961 

xJ 

'\ 

r 

■ 

C2S(e38)MB0 

